This editorial was first published in The Dallas Morning News. Guest editorials don’t necessarily reflect the Denton Record-Chronicle’s opinions.
It’s every patient’s financial nightmare. You have a medical procedure and are confident that there will be no financial surprises beyond your co-pays or deductibles.
No, a surprise can still await you, and a pricey one at that. Within days, bills will trickle in, all higher than you anticipated, for out-of-network care that you thought was provided by a doctor or a hospital in your insurance network.
Unfortunately, this occurs daily to hundreds of Texans, snaring them in the middle of contentious battles between insurance companies and medical providers. When providers and insurers can’t agree on payment, they often blindside patients with a substantial bill for the balance. Think of it as an expensive game of musical chairs. Insurers have a seat. Medical providers have a seat. Consumers are left to stand alone.
This pass-the-bill charade is about to end, thanks to Sen. Kelly Hancock, R-North Richland Hills, Sen. John Whitmire, D-Houston, Rep. Tom Oliverson, R-Cypress, and Rep. Trey Martinez Fischer, D-San Antonio. Their hard work throughout the legislative session shepherded a consumer-friendly fix through the House and Senate. Now it awaits Gov. Greg Abbott’s signature.
There’s much to praise about Senate Bill 1264, which removes patients from being collateral damage in billing disputes. It prohibits surprise medical bills from being sent to patients who have been treated by out-of-network providers when the treatment is an emergency and out of their control. It also clamps down on hefty charges for medical out-of-network care at in-network hospitals and out-of-network lab and imaging work.
In these instances, patients will be billed for only their in-network co-pay or deductible.
Providers and insurers can then battle over a fair payment with one another in an arbitration process that will have state regulatory oversight.
These significant new consumer protections build from previous efforts to give consumers some assurance that a trip to the hospital won’t make you sick again. In 2009, Texas allowed patients to challenge certain unexpected medical bills through mediation. The process, however, proved to be extremely complicated and mired patients in paperwork and bureaucracy. Unfortunately, patients remained on the hook to pay pricey bills.
We are pleased that Texas isn’t the only state to take this problem seriously. At least 25 states have laws protecting patients from surprise out-of-network bills, some more comprehensive than others, and many states that lack patient protections are considering enacting such legislation.
And in Washington, Sens. Bill Cassidy, R-La., and Maggie Hassan, D-N.H., have introduced legislation to address similar concerns, and other lawmakers are drafting protection bills in the House.
The need for health care is inevitable, but it shouldn’t come with unnecessary risk to a patient’s bank account. Medical costs still need to be made more transparent. The Legislature, however, has made medical care a bit less painful.